A Doctors perspective of switching from iPhone to Android

Sure, sinking might not be the best description of Apple at the moment. Perhaps after the release of the iPhone 5 and more record sales it would be more apt to say buoyant on green seas of cash.

So who in their right mind would be thinking about leaving Apple?

Well, I just did.

I’m going to try and document my swap from the shiny things with apples on them to bigger shiny things with little robots on them. There’s a lot of stuff out there on people making the switch. Despite my best efforts to find it, there’s not a lot from a medical perspective.

Hopefully as we go along some questions will be answered, and those thinking of swapping will get an idea of what they might be getting into. High end smart phones cost a pretty penny, so it’s probably a good thing to make an informed decision.

Before we get going a few caveats should be made. Firstly, a lot of this is personal experience. As always, YMMV (your mileage may vary). What works for me, what I use my phone for, and what I feel is important might not gel with some readers. Discussion about Apple versus Android tends to end up in flaming torches and waving pitchforks, so before we go putting on our Sunday best war paint, I think it might be worthwhile getting an idea of where I’m coming. Hopefully this might avoid any misunderstanding and give you an idea of where my biases stem from.

I’m a junior ED registrar (similar to post-graduate year 3 residency) in sunny Australia. Whilst I might be a tadpole in terms of medical experience, when it comes to technology in medicine, I’m pretty sure that I’ve mastered the use of my opposable thumbs. I’ve come from a background in web design, science, and briefly splashed in the business management puddle. In my med school days I was an early adopter of mobile technology in medicine. We’re talking when people actually knew what Palm PDAs were. When Pocket PCs were big enough to change your car tyre on.

Excuse the Apple hyperbole, but the iPhone was revolutionary. For the past few years I’ve enjoyed progressing from the iPhone 3G to 4. I’ve found it invaluable in both my studies and practice as a junior doctor. If I was forced to choose between my smart phone or my stethoscope, I’d probably take the phone.

I feel it holds that much importance in my day to day practice.

In my opinion, iOS and iPhone offered a phone and infrastructure better suited to the medical fraternity. It was, and remains, focused on user experience. It blends technology to purpose, and does so as seamlessly as possible. Yes, yes, I realise this sounds like it came from an Apple keynote, with some annoyingly catchy jingle playing in the background. But it’s true.

Smart phones have a unique application in point of care use in medicine. We’re often working in stressful circumstances, with limited time, and limited resources. We don’t always have time to pull out a 20kg text book (that’s 44 pounds for those of us with strange accents). We don’t have time to sit in front of a computer and read a fifty page Up-to-Date article. Almost all of us have a smart phone now. Even the Luddites amongst us are using them as flint and steel to start fires. For a long time, I’ve felt the iPhone was the choice for this situation. Being able to be at the bedside and have a clinical question answered quickly is vital.

The App store is massive. The medical section is burgeoning with useful references, calculators, scoring tools, patient education tools, anatomy apps etc. Thanks in part to the closed ecosystem, there is also often higher quality than what’s offered elsewhere. Combine this with the sleek user interface and amazing user experience and you’ve got one handy device.

Here’s how I typically use my phone. As a junior doctor, I’m acutely aware of my shortcomings, and even more so the potential to address some of these with mobile technology.

A 50 year old male presents with acute shortness of breath. You go in to see him, and start the usual history, examination, assessment, and management. After getting the most urgent considerations out of the way I’ll then have some time to think. I’ll often pull out Diagnosaurus and flip through the differentials of shortness of breath, sure it’s not the rarest presenting complaint, but as Atul Gawande pointed out (1) sometimes checklists are good things and help us make less mistakes. I’ll have one or two differentials closest in mind, so I’ll flip through Epocrates and remind myself of the pathophysiology at play here. Unsurprisingly, I’ll find that they even have a guide to the urgent evaluation of shortness of breath. I’ll skim through the pertinent history and examination of an acute PE like garlic to a medical vampire-lawyer, I’ll remember to include the significant negatives on my documentation.

Not stopping there, I’ll pop up the PERC rule, Well’s criteria, and have a think about those as well. I’ll look at the ECG and no doubt forget the most common findings in PE — actually I won’t, thanks to Amal Matu’s free and excellent teaching page (2). No worries, ECG guide is open in seconds and I’ve already read the PE section with the evidence based references. This is just the tip of the iceberg; I’ll be writing more on other things I’ve found smart phones invaluable for later.

I’m getting point of care, evidence based information. It’s helping me to learn on the spot. It’s quick, seamless, and there are a whole lot of possibilities thanks to the massive range of apps on the store.

So why switch? Why not stick with what I know? Why not stick with Apple?

Android is catching up. Perhaps already has. iOS apps are making it over to the Play store. The hardware has caught up. I recently played with my brother’s Samsung Note (he’s also a doctor). It was big. It was shiny. And it was pretty cool. The response times were similar to that of an iPhone. Scrolling was smooth. Apps loaded quickly. He had an impressive range of medical apps. He had customised the hell out of his phone to tailor his needs, perhaps a bit more than I was able to on my iPhone 4.

Because I was so happy with my iPhone, I realised I’d missed out on much of Android’s improvements.

Then the new iPhone 5 was released. I was reading all the rumours. Waiting to be Wowed again. The release event came and went. I sighed. My expectations were too high. Sure the phone was a sensible advancement on the 4S, I just expected something more.

I started looking around to see what else there was. I started reading reviews on the new android phones coming out. Late nights were spent watching YouTube reviews on the Samsung Galaxy Note 2.

I felt dirty. I was drooling over phone reviews.. and I was watching them on my iPhone. I started to notice the little scratches in the screen some more. The backing plate that I’d replaced suddenly didn’t seem quite so shiny. Its curvy corners that were once so appealing started to seem bland and boring. I convinced myself I needed a change.

Whilst I’ve got an itchy eBay trigger, I’m typically someone that wants to know what I’m getting into before forking out a decent amount of cash. I couldn’t find any in-depth opinion pieces on people who had recently made the switch, so I figured I’d give it a go and see what it was like.

I don’t feel the divide between the two big smart phone options is as great as it once was. It was once big enough that I’d occasionally peek over the edge, shuffle back, and put my head firmly in the sand. I think it’s shallow enough now that I just might be able to step over it.

Over the next few months I’ll be writing about my experiences with Android and ultimately who I end up going with. As I mentioned in the beginning, YMMV. Also, Apple fanboys, please read this full article before passing judgment.

(1) This is the book I was referring to. Good read. About reducing errors in medicine. http://gawande.com/the-checklist-manifesto

Mick is a junior ED registrar currently working on the Sunshine Coast, Australia. He graduated from the University of Queensland. He is currently planning to locum and travel before settling into a training program in either Australia or the UK. He has a passion for mobile technology and its use in medicine, and feels that it is currently underused in a clinical setting.

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iMedicalApps

iMedicalApps periodically features contributed articles from clinicians, researchers, and industry leaders with interesting perspectives to share.

Very interesting. Before I have my Galaxy Note using an Ipod for electronic assistance, but between the two systems, Android and Apple, it seems particularly attractive to go with the robot. Here is worthy to mention that the real advantage in terms of my current phone is the screen size, which truly makes the difference. Virtually the supply of medical applications for both platforms is the same and, as it progresses improved processors for mobile, secure the final decision will be more a matter of taste and affinity for technical advantages between the two.

Where medical apps are concerned, I think part of the challenge is app selection and availability as much as hardware. Too many non-medical apps categorized as “medical” – especially as relates to those targeted for physician use. Great idea to document your journey. Will be interesting to hear your experiences, thanks for taking the time.

Android may have the biggest user share, but in terms of actual use of Internet and apps, iOS beats Android every time!
You say wonders about Google Play Store, do you realize that NONE of the apps on Android are tested about security and privacy? Every 12 year old kid can make an Android app these days. Your patients records, for instance, may be already on some Android’s developer database and God knows what he will do with it.
Apps in the App Store are controlled and tested for privacy, security and great user experience. There are hundreds of Android models and an app needs to adapt to each one of those models, but iOS apps need only to adap to four models. That’s why an app launches first for iOS and after, if there’s time, there comes an Android version a year or two later. And watch closely to the quality of apps between App Store and Android Store, there’s clearly a winner.
Big developers like Elsevier, Lippincott, and others are more willing to develop an app for iOS because they make more profit. More than 75% of all Android devices are used only for phone calls and text messaging. That’s why user share for Android Vs iOS is misleading.
Android is crippled and fragmented, there are, at least one Android version for each mobile manufacturer (Samsung, LG, Sony…) and none gets updates on time. If you have Android 1.6 you’ll stick with it for years, without getting bug fixes of security updates.
But, in the end, that’s your choice.
I only wrote here because these details were not said here.

Did you get the Note 2? If so I’d like to know if you think the stylus adds to your productivity. My wife just bought an iPhone 5 but she hesitated before buying because of the possibility of the stylus on the note.

She has a (now obsolete) windows laptop with a stylus and likes the Stylus a lot. She often uses a capacitive stylus with our iPad but doesn’t find it very good compared to the wacom on her laptop.

I think she could be convinced to switch to Android if the stylus proved to be useful for doctors.

I’m considering making the switch from my iphone 4 to the Note II when it’s released because like you I’ve become bored with the stagnant iOS. I’m hoping your review will answer some if my questions about the GTD functionality of the Note.

My last line: Why drive a Chrysler when you can drive a BMW?
And I switched back to iOS. I just found it more polished.

I also appreciate your perspective. Moreover, since my “experience”, Android has improved significantly, and iOS not so much (in my opinion) — but I still recently got an iPhone 5 😉

Just a few details that I picked up on in your post:
“Thanks in part to the closed ecosystem, there is also often higher quality than what’s offered elsewhere.” — I don’t think the open vs close is key here. Most medical apps don’t make use of “open” features of the OSes. Let’s face it; most “medical apps” are not feats of advanced technology; they are usually basic calculators or references, requiring programming knowledge, but from a technical perspective, we’re not talking Photoshop-level coding.
I think the main reason for the difference in quality and absolute number of apps is adoption, especially for the medical category. We recently released our flagship app, MD on Call, for Android. Lanthier – Practical Guide to Internal Medicine, has been out for a few months now. Both are selling at around 1/6-1/7 their iOS counterparts. It is something developers need to consider before developing for Android — and they do.

As long as the apps that you need are available on Android you should do just fine with the switch, as I found out when I did. I’m looking forward to your experience! Be sure to check out our apps!

Marc-Emile — Around the time you wrote your post I was trying out the Galaxy Nexus as well. I think with the release of ICS OS, Google finally took a huge step forward towards parody. I think the biggest thing holding them back is the lack of a universal experience on all devices — and thats an issue they are going to have w/ an open OS as well. Carries such as Verizon put so much crap software bundled with the OS that makes the devices not nearly as good as the ones with a clean OS. It’s the same issues with the Windows OS. If you get a clean Windows 8 CD, you have a pretty good experience. If you get a laptop with Windows 8 already on it, you get so many junk apps that really diminish the experience.

Indeed. That part of Android’s “openess” is holding it back. Approximately 25% of our sales are still on Android 2.3.x. (!) This really cripples the “Android experience” for numerous people, who, unfortunately, are probably not even aware of it. That tie-in to carrier and manufacturer is even a security hazard, as people don’t have access to the latest security updates. If I was going with Android, I would definitely get a Nexus device to get quick access to the latest updates from Google.

From an historical perspective, what Apple did with the iPhone was more that bringing a nice, clean, touch device to the market. The other big achievement was to make if free from carrier influence. That’s something Android is still struggling with, and the main drawback to its “open” platform.

An interesting article. The biggest problem to switching is the actual investment (money-wise) I’ve made in iOS apps. Buying them all over again for a different phone is a big ask. Changing to a different phone that may have more bells and whistles might be great from a geek pov but as someone mentioned above, most medical apps aren’t that complicated (Basically references and calculators) – Do you need the extra bits?

What I’d really like to see is medical accessories for the iPhone. Have you seen node (check kickstarter). Great concept with potential.

This is a GREAT point. With apps that require subscriptions, such as UpToDate, thats not a problem. But with apps that you actually purchase through Apple — and medical apps can be expensive — you have to buy them again, which is a huge issue. For example, I use EMRA antibiotics guide in the ER a lot, and I had to buy it again on my Android device — not ideal.

Well, I’ve payed a lot to use my iPhone as my work friendly assistent. I’ve bought books (I dont use material books anymore), I’ve bought apps, I’ve spent time learning how to use those tools the best way as possible. It cost money; Besides, my iPhone 4 is like a mobile phone. It is not like to use a ‘pocket-size’ 43″ TV set. In my opinion, it makes a huge difference when I have to search some topic in front of my patient. But I’m not an Apple slave. When I notice that I can have the same quality and variety of secury medical android tools, I’m sure I will think about to move

Hi everyone.
Thanks for the feedback.
Sorry for the late replies, just finished night shifts and trying to get back to humanity.
Writing the second next bit about the experience so far as we speak.

@Jose, not sure who’s saying wonders about the play store. as for the app quality, i’ve already touched on the fact that apples more closed ecosystem lends itself towards typically more polished software, both from the approval system, limited app distribution (no 3rd party app stores unless you jailbreak) and the restricted hardware. I think you might have missed the point of this series, i’m writing about the experience to explore more fully the difference between the two systems, involving everything that you’ve mentioned.

@benoit, yessir. Note 2. i think the stylus is something that’s going to vary a hell of a lot between people. i haven’t used it much so far. i find the screen size, whilst large for a phone, isn’t quite large enough to write a whole lot on. i found that writing on a digitiser, not specifically this one, tends to be a whole lot more clumsy than pen and paper. i used to have a TC1100 tablet way back which felt the same. the stylus and integration is pretty great on the device though, fantastic for a quick note or two, though i’d suggest that long amounts of writing would be tiresome. i’ve also enjoyed using it for annotating pictures, particularly useful with evernote skitch.

@nicole, we talking about Getting things done functionality? shoot your questions this way. can hit me up on twitter @mick_kerr if you want or here.

@marc-emile, as for the closed Vs open, i’m talking about the software hoops apple sets to publish something Vs open stores, as well as the limited hardware platforms they have to develop for. i’ve found quite a few apps thus far that aren’t designed for the Note 2s display. most apps on the apple store are deigned for all the available resolutions of ios devices. even after a new release, such as the iphone 5 with the new screen resolutions / size, the apps tend to get updated quite quickly.

@marc-emile, ahh, MD on Call, i’ve used that before for ward call. not bad.

@jose, again :). the itunes U content doesn’t limit you to only apple products. certainly able to consume that content on an android.

@russell, agreed. repurchasing apps has so far been a significant downside. will be writing about the apps in ios Vs android with what I used daily.

@luis, this was actually part of my interest in changing. would the larger screen size make using the phone at a bedside for reference make the experience better (more screen real estate) or worse (larger, more cumbersome)?

Pls move over fast and tell us your experience. Am also smart phone crazy and don’t joke with my android. Its like for me a second skin because I depend heavily on it. So like I said earlier can’t wait to read your other further write-ups, at least i now know am not the only doctor using android because every single collegue of mine uses an Iphone. We can compare notes on whats new we in the android medical setting.

Interesting perspective – but I moved from Samsung/Android to iPhone 4S and have not looked back since. iPhone is a much superior device than the Samsung device that I used for over a year in the clinic. There are three major factors that made me look at iPhone and iOS. 1) You state that Android Apps are just catching up, but they aren’t. As an ER physician there are more choices of EMR apps that are native only to iOS than on Android. Some of these major EMR’s are providing progress notes via speech recognition with a full medical dictionary. Charge capture on the phone when you’re done with a patient saves a lot of time in billing. These apps are a huge time saver for busy practicing physicians like me.
2) As physicians we have a responsibility of making sure Patient Information is secure. None of the Android phones have any hardware encryption. So in the event of a lost or stolen iPhone – a remote wipe would be milliseconds vs. hours of flipping bits for a software wipe on Android.
3) Malware: Do you know there was a 700% increase in viruses in one year on Android. http://www.ibtimes.com/mobile-malware-increased-700-over-2011-android-no-1-targeted-platform-mcafee-779557

What would happen when your son purchases a game-app from the multiple unscreened Android stores and your Samsung gets infected with malware that listens in on any conversation you are having with a patient. Do you know how explosive that would be Dr. Kerr? And what sinking Apple ship are you talking about – a company that has enough money to buy Samsung, Google and Microsoft – all at the same time? I think you are just bored with the iPhone and moved to another platform – without really putting much thought to it.

This article really doesn’t say very much. There’s no real comparison between the iPhone and android. I tried a galaxy S3 and found it to be a subpar experience, especially with navigation and overall user interface. I also had a Nexus 7 with similar difficulties. A number of apps on the Google play store were incompatible and I found myself making compromises in my day-to-day use. I’m back to an iPhone 5 and just purchased an iPad Mini which I think is really the best device one can use in in a medical setting. (Dictated with Siri on my iPad Mini.)

@Mick Kerr: Read your article twice to try and make sense of what you were saying. Thus took the time to even respond to this article (which still has no concrete or sensible reasoning). Best of luck with your Galaxy – you clearly are in the micro-minority. The latest KLAS report released 2 weeks ago, found Apple iOS to be the 800-pound gorilla in the world of mobile healthcare computing. There is a reason why physicians choose iPhone and iPad in the clinic. Ninety-four percent of the organizations and physicians surveyed support the Apple iOS.

So the key is for this to not dissolve into a fan boy conversation. Just some things to clear up.

1) You shouldn’t be storing any patient information on your phone. All the information you access should be pulled from a server that requires password protection each time. So that in itself is a moot point.

2) If someone creates a virus that then enables them to “spy” on your phone conversations with your patients?! Wow.

Anyhoo. I think the biggest thing Dr. Kerr was trying to impress was that Android is definitely catching up and there are a lot of intangibles that need to be taken into account as well. Everyone knows more physicians use iOS than Android. It’s pretty obvious. As the comments show, there are a lot of other physicians who are actually considering Android now that were not before.

@Dr. Husain – with all due respect as the Editor of this blog, lets not allow comments that make this an Android fan boy conversation either. Just by allowing statements like “Mutiny is afoot! I’m leaving the sinking ship that is Apple.” – does not bode well for this site whose readers in majority are very passionate about their iDevices.

As far as your two points. 1) There are – FDA cleared apps on iOS that have PHI resident on iPhones (data-at-rest), that do meet all HIPAA compliance from file-level encryption, to remote wipe, to full hardware 256bit-AES encryption. My IT department feels confident that they have allowed this app with PHI to reside on the iDevices, with dual-factor authentication and VPN turned on. BTW Android devices are not allowed at our Hospital by IT.

2) I was a resident at UCLA and when we got movie stars in for a procedure – the amount of hackers trying to get into radiology DICOM servers or other parts of UCLA IT – exponentially grew the day someone famous got admitted. So “yes” hackers trying to listen in to your conversation is a real threat and its easy to trick your Samsung Android platform to allow such Malware – that even the FBI felt necessary to highlight. Let Android play catch up to iOS, they have a long way to go.

Mate. The sarcasm in the opening “sinking ship” comment was meant to be unmissable. I then tried to qualify my opinion further with my background which has been firmly rooted in ios for quite a while. I was trying to avoid replies such as yours by making the first post of the series so clearly a disclaimer and orientation piece. I’m sorry you didn’t comprehend it the way I intended. I don’t want to inflame the situation further, so let me be crystal clear. I still think ios is fantastic. I’m trying out android to see where it’s at these days. that’s all. Cheers.

@ Dr. Nathanson raises some valid points here. The security issue is not to be taken lightly and I’m sure your story about the hackers trying to get into radiology servers is not an isolated occurrence. Despite that being from the “backend” side of things, it goes to demonstrate how important the problem is, and forces us to think of how a mobile device could be used in bad hands.
The “spy” app you describe is probably not that far from the truth, unfortunately.

Android users definitely need to be more careful and “streetwise” than on iOS, which can be a big problem in a mission critical environment. A few simple tips for users:

– Get your apps from Google Play or other reputable app stores (Amazon…) NOT from email links or text messages
– If it’s too good to be true, it probably is.
– Read the permissions you’re agreeing to when installing the app (yeah, I know, people rarely do that…)
– You might want to install an antivirus on your device.

For those that are not aware:

Apple reviews every app on the App Store and decides to allow apps based on their criteria. — lots have been written on that topic — Therefore, it usually catches “bad” apps before they’re made available to the public. The App Store is also the only way of installing apps on iOS (except if the device is jailbroken, which is another topic altogether…) On the opposite end, any app can make it to Google Play. There is no review process, so any developer can make pretty much anything available on the platform. It’s also possible to install app from any source (ie sketchy websites, email links…). There’s essentially no control over the apps a user can install, and what those apps can do. This is what makes Android devices nice to developers (no limits), but also nice to hackers (the bad kind of hackers)

Had iphone 4 for a couple of years. Amazing technology. My disappointment came with the lack of screen increase & many itunes diemma. After much research, I have the note 2. I love it & it has exceeded my expectations. I use my “phone” as a computer, 95% of the time, so having the massive screen was the selling point. I now find myself writing straight onto photos, taking instant notes when I pull out the stylus & dont have a problem with the stylus at all. I then either email my printer which prints out as soon as its retrieved ( as the printer has its own email address) or save into “dropbox” to access it from any of our design stations. Ive had the 2 for 3 months now. The ability to have 2 applications on the screen & a scalable video running at the same time is amazing. I bought the 2 online from Singapore & it came with French instructions for AUS$590. It wasnt a problem to access everythiing I needed to get up and running from the abundance of youtube videos & the help directly from Samsungs website. I am an professional artist and have a medium size sign manufacturing business. I agree that teh ios is easier to use as you are forced to use it their way however after the learning curve, which was a full weekend with my head in forums, videos, & instructions, I cant see me changing until the iphone catches up to what the note 2 offers me. Many of my friends have the iphone 5 & are very impressed with choosing the note 2 over the iphone 5 however for many of the reasons already stated, others wouldnt change…. Learning curve, apps already purchased, & iphone exchange policy if something should go wrong. Loved the iphone, love the big screen & stylus more. Sorry if this is a little jumbled…typing as I speak & not proof reading. Happy New Year!

Hello, i was interested in this post and thought Android well worth the exploration until today. I have both an iPhone (3S) and a high end Android phone that is 2 years old which cost just as much as an iPhone. Today I discovered that I could not access Google Play which has replaced the Google Marketplace for downloading Android apps. My 2 y.o. HTC has vsn 2.2 Android on it but 2.3 is needed to access Google Play (and thus all newly created android apps). A phone call to HTC told me that there is no intention by HTC to update the version of Android for my model, resulting in me being destined to no longer access the latest apps. By contrast, my old iPhone has the latest software and still serves me very well. Who would want to pay near $1,000 for a high end android phone only to find it defunct within 2 years – I for one will never go there again!

Android Vs. Apple aside. I agree with the security sieve that is android, but I also agree that it is the medical professional’s responsibility to make sure no PHI is available to “hackers” to steal. If your way is to use the iOS device, more power to you, enjoy your device. If you like to take more of an active role in your device (I find I know my device better and can deal with it better when something goes wrong) then android is the way to go. The security is an issue that should be met with developer support, I would be more inclined to buy an app that bosts more security that one I clicked on in an email (who does that btw???)

With the advent of multiple accounts in Android 4.2, I don’t know why you would hand your device to a child and say “go at it” without making it as secure as possible. That being said, I don’t let my tablet out of my hands unlocked for any reason (not even my wife) unless I am there where I can monitor it’s use.

I don’t have any PHI on my tablet as an RN, but hope to develop an app that will make organizing information for nurses on the unit much easier (ed, surgical, ICU, PACU, etc).
My hope is to see technology and patient care more closely associated. I want to see tablets carried by nurses with the ability to pull patient information up with the touch of the screen; infusion pump/patient information sent wirelessly to the care giver directly rather than phoning/paging the nurse. All possible with technology (or hopefully soon to be possible) whether iOS or Android.

Regardless, I’ll continue to read this series and quietly (or not so) root for the android device to win out.

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